Get Geoblue Xplorer Individual Enrollment Application

Filling out the GeoBlue Xplorer Individual Enrollment Application online can be a straightforward process when you know what to do. This guide will provide you with detailed, step-by-step instructions to ensure your application is completed accurately and efficiently.

Follow the steps to complete your application correctly.

1. Press the ‘Get Form’ button to access the enrollment application and open it in your preferred editor.
2. Begin by providing the primary applicant information. Fill in the last name, first name, and middle initial in the respective fields. Include details like the applicant’s Social Security number and Visa or Passport number.
3. Complete the address sections. Be sure to include the street address, apartment number (if applicable), city, postal code, and country for both the address outside the U.S. and the address inside the U.S.
4. Provide contact information including home phone, daytime phone, email address, and marital status. Ensure that the information provided is current and accurate.
5. Indicate the reason for applying, whether for new enrollments, adding dependents, or changing an existing plan, and provide the corresponding I.D. number if applicable.
6. Answer questions on time and location status. Specify the time you expect to spend outside of your home country and the relevant locations.
7. Select your choice of plan. Indicate your preference between GeoBlue Xplorer Premier or GeoBlue Xplorer Essential and choose any additional riders like prescription drug coverage.
8. List all persons applying for coverage, providing their relationship to you, and complete necessary personal details for each applicant, including height, weight, date of birth, and Social Security or Visa/Passport number.
9. Complete the health history section carefully. Ensure all questions are answered accurately as this is critical for the underwriting process. If answering 'Yes' to any health condition, provide detailed information in the subsequent sections.
10. Review the conditions of application, confirming that you understand the implications of your submission and that you agree to the terms outlined.
11. Finish by signing and dating the application where required. Ensure all applicants over 18 also sign and verify the information provided.
12. Once all fields are completed, save your changes. You may download, print, or share the finalized form as needed.

Take the next step towards your health coverage by completing your GeoBlue Xplorer Individual Enrollment Application online today.